Method and apparatus for forming multiple cavities for placement of hair grafts

ABSTRACT

A method and apparatus for forming multiple cavities in the tissue of a patient into which hair transplant grafts are placed is disclosed. The apparatus comprises interengaging plates. A first plate includes a number of downwardly extending spikes for extension through a number of downwardly extending hollow catheters of a second plate. The first and second plates are pressed together with the interengaging spikes and catheters penetrating the tissue. The first plate is removed, leaving cavities formed by the hollow catheters of the second plate. A third plate having downwardly extending hollow catheters filled with hair grafts is sleeved into or aligned with the catheters of the first plate. The hair grafts are pressed downward through the third plate, through the first plate, into the scalp, preferably by use of rods extending down from a fourth plate. The third plate may take the form of a rotatable circular wheel or replaceable cartridge which has bores therethrough for holding hair grafts, which is located between the first plate and the second plate.

RELATED APPLICATION DATA

This application is a continuation-in-part of U.S. patent applicationSer. No. 08/395,455, filed Feb. 28, 1995, still pending.

FIELD OF THE INVENTION

The present invention relates to the placement of hair grafts. Inparticular, the invention is a method and device for forming a pluralityof cavities in a predetermined pattern for positioning of hair grafts.

BACKGROUND OF THE INVENTION

Hair transplants have become commonplace over the last few years. In oneof the newest technique of transplanting hair, small "grafts" of tissuecontaining only a few hairs are placed in sites on a recipient's scalp.

In particular, hair from other portions of the recipient are cut intovery small cylindrical sections, or grafts. The recipients scalp isanesthetized, and then expanded by infusing saline into the scalpbeneath the galeal layer. The surgeon inserts a needle-like dilatorthrough the scalp, including the galeal layer, forming a cavity. Thedilator is removed, and a donor graft is inserted into the cavity.

The success rate of this technique depends primarily upon whether thedilator succeeds in forming an cavity which extends below the galeallayer, and upon the time lapse between preparation and insertion of thegraft.

New techniques in hair grafting require a large number, often 200 to600, grafts to be placed during a single session. In the presenttechnique, dilators are individually placed by hand. This is not onlytime consuming, but is inexact, since the surgeon places the dilatorsessentially randomly.

In order for the transplanted hair have a uniform look and propercoverage, however, the grafts must be arranged on the scalp in specificpatterns. For example, numerous small grafts are often placed near thehairline, while larger grafts are placed less densely on the top andrear of the scalp.

A need exists for a method of easily forming cavities into which hairgrafts are inserted and for controlling their location and number ofdilators inserted across the entire scalp.

SUMMARY OF THE INVENTION

The present invention is a method and device for forming a number ofcavities in the tissue of a patient into which hair grafts are inserted.

In one form of the present invention, a cartridge includes a four-sided,walled housing having open top and bottom ends. A template or guide isremovably located in the housing, recessed from a bottom edge of thehousing. A plurality of passageways are located through the guide forcontaining a plurality of dilators in a grid pattern therein.

The dilators are releasably retained in the passageways of the guide byfriction between the dilators and the guide. Each dilator includes alower or proximal probe portion for insertion into the scalp and anupper or distal grip portion by which the surgeon grasps the dilator.The distal grip portion is smaller in outer dimension than the probeportion.

The distal end of the dilators faces the top end of the housing, and theproximal end of the dilators faces the bottom end of the housing. Adepressor is located over the open top end of the housing proximate thedistal end of the dilators.

A surgeon places the cartridge on the patient's scalp with the bottomedge of the housing resting on the patient's head. The surgeon pressesdownwardly on the depressor, forcing the dilators downwardly out of theguide into the tissue of a patient. Once the dilators are inserted, thehousing is removed from the scalp.

In a variation of this form of the present invention, the depressor is aplunger connected to an actuator. In this form of the invention, thehousing of the cartridge is adapted to engage the triggering mechanismof an actuating mechanism, and triggering of the mechanism causes theactuator to depress the plunger, forcing the dilators from the guideinto the tissue.

In other forms of the present invention, the housing is a cylindricaland rotatable with respect to a base member which adapted for insertioninto a triggering mechanism. The housing includes a plurality ofpassages therein in which dilators are located. An actuating memberpasses from the base member through the housing to a plunger locatedproximate a first end of the dilators located in the passages. When asurgeon triggers the mechanism, one or more dilators are forced out ofthe passages into the tissue of a patient. The surgeon then rotates thehousing with respect to the base, aligning another passage for actuationby the firing device.

In yet another form of the invention, the device for forming thecavities in the tissue comprises a female template having a number ofdownwardly depending guides with passages therethrough, along with amating male template having a number of downwardly depending spikes.When engaging one another, the spikes of male template pass through thepassages in the guides of the female template, forming a single templatewith downwardly extending "dilators."

In use, a surgeon presses the dilators of the combined male and femaletemplates into the tissue of a patient. The surgeon removes the maletemplate, leaving the female template in place. The surgeon then pressesa third template having downwardly extending hollow guides eachcontaining a hair graft into the female template. The surgeon pressesthe spikes of the male template through the guides of the third andfemale templates, pressing the hair grafts downwardly. Then the surgeonremoves the templates, leaving the hair grafts positioned in the tissue.

In another version of the present invention, the device for creatingapertures in the tissue and placing the hair grafts comprises fourinterengaging plates. An incision catheter plate comprises a base havinga number of downwardly extending hollow catheters aligned with bores inthe base. An incision needle plate comprises a base having a number ofdownwardly extending spikes for extension into the catheters of theincision catheter plate. A hair graft catheter plate comprises a basehaving a number of downwardly extending hollow catheters aligned withbores in the base. A hair graft needle plate comprises a base having anumber of downwardly extending rods.

Posts extend upwardly from the incision catheter plate for engagementwith bores in each of the other plates for aligned stacking of theplates.

In use, the user presses the incision needle plate and incision catheterplate together until the spikes extend just beyond the open end of thecatheters. The user presses the plates downwardly so that thespikes/catheters extend into the tissue of a patient. The user removesthe incision needle plate, leaving the catheters of the incisioncatheter plate located in the tissue.

The user presses the hair graft catheter plate (with hair grafts loadedinto each catheter) downwardly until the catheters thereof are locatedin the catheters of the incision catheter plate. The user then pressesthe hair graft needle plate downwardly so that the rods thereof extendinto the catheters of the hair graft catheter plate, thus pressing thehair grafts downwardly. The user then removes all of the plates, leavingthe hair grafts in the tissue of the patient.

In another version of the present invention, the device for use increating apertures and placing the hair grafts comprises a lower plate,upper plate, and at least one cartridge. Hollow catheters extend fromthe lower plate, and are aligned with bores passing therethrough. Spikesextend downwardly from the upper plate, which is movably mounted abovethe lower plate. The cartridge is located between the upper and lowerplate. In a first form, the cartridge comprises a rotatable wheel havingseveral sets of bores which are alignable with the catheters/spikes. Ina second form, the cartridge comprises a small individual plate having aset of bores therein. Means are provided for aligning the bores in thecartridge(s) with the spikes catheters.

In use, a user presses the upper plate downwardly, extending the spikesthereof through empty bores in the cartridge and the catheters. The userthen presses the entire device downwardly until the interengagingspikes/catheters extend into the tissue of the patient. The user thenlifts up on the upper plate, and either inserts a loaded cartridge orrotates the cartridge, so that bores filled with hair grafts are alignedwith the catheters. The user then presses the upper plate downwardly,pressing the hair grafts into the catheters. The user then removes thedevice, leaving the hair grafts in the tissue of the patient.

In this form of the invention, the user may preload large numbers ofhair grafts into the cartridge(s), thereby allowing him to place largenumbers of grafts in uninterrupted fashion.

Further objects, features, and advantages of the present invention overthe prior art will become apparent from the detailed description of thedrawings which follows, when considered with the attached figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a single dilator for use in the presentmethod;

FIG. 2 is a perspective view of the dilator of FIG. 1 inserted into thescalp of a patient;

FIG. 3 is a perspective view of the dilator of FIG. 2 being removed fromthe scalp, and being replaced by a hair graft;

FIG. 4 is a partial perspective view of a manually operatedmultiple-dilator placing cartridge in accordance with the presentinvention; and

FIG. 5a is a front end view of the cartridge of FIG. 4 with a depressorthereof in a first, retracted position;

FIG. 5b is a front end view of the cartridge of FIG. 4 with a depressorthereof in a second, depressed position;

FIG. 6 is a perspective view of a patient's scalp, illustrating thatcertain portions of the scalp require differing hair graft sizes anddensities, and thus differing sized dilators and dilator insertionpoints;

FIG. 7 is a perspective view of a second embodiment of the presentinvention, illustrating an automated revolving single-shot dilatorcartridge;

FIG. 8 is a perspective view of a third embodiment of the presentinvention, illustrating an automated rotating multiple shot dilatorcartridge;

FIG. 9 is a top view of a fourth embodiment of the present inventionillustrating an automatically operated dilator insertion cartridge;

FIG. 10 illustrates a second form of dilator for use in the methods anddevices of the present invention;

FIG. 11 is a partial perspective view of a male and a female template ofa fifth form of the invention;

FIG. 12 is a cross-sectional side view of the male and female templateof FIG. 11 shown engaging one-another and pressed into the tissue of apatient; and

FIG. 13 is a cross-sectional side view of a third template engaging thefemale template of FIG. 11, with the male template engaging the thirdtemplate.

FIG. 14a is a perspective view of an incision catheter plate of a sixthform of the present invention;

FIG. 14b is a perspective view of an incision needle plate of a sixthform of the present invention;

FIG. 14c is a perspective view of a hair graft catheter plate of a sixthform of the present invention;

FIG. 14d is a perspective view of a hair graft needle plate of a sixthform of the present invention;

FIG. 15 is a side view illustrating the interengagement of the incisionneedle plate and incision catheter plate;

FIG. 16 is a side view illustrating use of the incision needle plate andincision catheter plate for forming multiple cavities in tissue of apatient;

FIG. 17 is a side view illustrating interengagement of the hair graftneedle plate, hair graft catheter plate, and incision catheter plate,whereby hair grafts are pressed from the hair graft catheter plate intocavities formed in the tissue;

FIG. 18 is a perspective view of a device of the seventh form of thepresent invention; and

FIG. 19 is a perspective view of an alternative embodiment of the deviceof the seventh form of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The present invention involves methods and devices for simultaneouslyforming cavities in the tissue of a patient into which hair grafts arelocated. In particular, the methods involve pressing dilating elementsinto the tissue of a patient to form cavities in which hair grafts areplaced.

FIG. 1 illustrates a dilator 20 for use in some of the methods anddevices of the present invention. In general, the dilator 20 comprises adistal handle portion or end 22 and a proximal probe portion or end 24.Preferably, the very end of the handle portion is blunt, and the veryend of the probe portion is pointed. As illustrated in FIG. 2, thedilator 20 is inserted in the tissue of a patient, normally the scalp,for creating an cavity into which a hair graft 26 is inserted. In afirst method in accordance with the present invention, a number ofdilators 20 are simultaneously located in the tissue when a surgeonmanually presses on a dilator-engaging depressor 38, pushing a number ofdilators through a guide 36 into the scalp, as illustrated in FIGS. 5aand 5b.

In a second method, a series of single dilators 20 are inserted into ascalp upon actuation of a gun or other remote triggering device, via thecartridge illustrated in FIG. 7. In a third method, multiple dilators 20are inserted into the scalp when a surgeon actuates a gun, via thecartridge illustrated in FIG. 8.

In a fourth method, a number of dilators 20 are simultaneously insertedinto the scalp when a surgeon triggers an actuating mechanism connectedto the cartridge 300 illustrated in FIG. 9.

In a fifth method, the interengaging templates illustrated in FIGS.11-13, which include downwardly depending dilating spikes and guides,are used to penetrate the tissue and form open cavities into which hairgrafts are inserted.

More particularly, and referring again to FIGS. 1-3, in a first form,the dilators 20 of the present invention are preferably cylindrical inshape, and about 2 cm long from end to end. In particular, the handleportion 22 is about 1 cm long and about 0.5 mm in diameter. The probeportion 24 is about 1 cm long and has a larger diameter than the handleportion, being about 1 mm in diameter. The dilator 20 tapers to a sharppoint at the very end of the probe portion for piercing and penetratingtissue, over about the last 0.25 cm of the dilator.

Most importantly, because the handle portion 22 of the dilator 20 has asmaller outer dimension that the probe portion 24, a cavity which islarge enough to accept a hair graft is formed when the dilator isinserted into the scalp, and yet a sufficient distance between thehandles exists to allow the surgeon to grasp them and work between them.

FIGS. 1-3 illustrate, in overview form, use of a single dilator 20 tofacilitate hair graft 26 insertion. First, the dilator 20 is presseddownwardly into the scalp 28 into the galeal layer 30. Penetration ofthe scalp 28 is facilitated by the tapered end of the dilator 20.

Once inserted into the tissue of a patient, the enlarged probe portion24 expands the surrounding tissue, as illustrated in FIG. 2. Afterinsertion, the surgeon removes the dilator 20 as illustrated in FIG. 3,leaving an cavity into which the surgeon inserts the hair graft 26. Theresiliency of the tissue ultimately causes the tissue around the hairplug 26 to close, securing the graft in place.

FIG. 4 illustrates a manually operated device for use in placingmultiple dilators 20 in accordance with a first method of the presentinvention. In accordance with this method, by manual effort, a surgeonsimultaneously places a number of dilators 20 in a predeterminedarrangement. The device for accomplishing the method is a cartridge 32which comprises outer support means in the form of a housing 34 havingthe form of a contiguous upright wall, a dilator guide 36, and adepressor 38 (see FIGS. 5A and 5B).

The housing 34 of the cartridge 32 is preferably square or rectangularin shape. The particular size, in inner dimension and thickness, varieson the number of dilators to be placed and their size. When four-sided,the housing 34 has a first side 56, a second side 58, a third side 60,and a fourth side 62, and an open top end 39 and bottom end 40.

Preferably, the first, second and third sides 56,58,60 are rigidlyconnected, forming a "C"-shaped member. The fourth side 62 is movably orremovably connected to the other sides. In particular, the edges of thefirst and second sides 56,58 which engage the fourth side 62 include a"C"-shaped channel. The fourth side 62 has inwardly facing tabs 64,66(66 not visible) on opposing edges which slide in the channels of thefirst and second sides 56,58. The fourth side 62, as illustrated in FIG.4, is thus detachably connected to the first and second sides 56,58.

Preferably, a stop 68 in the form of a solid member covering the top endof the channels 64,66, limits downward movement of the fourth side 62 onthe first and second sides 56,56. When connected to the first and secondsides, the fourth side completes the contiguous wall comprising thehousing 34.

Each of the sides is made of plastic, or a similar durable andsterilizable material. When made of plastic, the first, second, andthird sides 56,58,60 can be molded as a single piece.

Dilator guide means in the form of a guide or template 36 are located inthe cartridge, recessed a short distance up from a bottom edge 41 of thehousing 34 on the interior thereof. The particular recess distance ischosen so that when the cartridge 32 is placed on the scalp, the tips ofthe dilators 20 located in the cartridge 32 are proximate the scalp, asillustrated in FIG. 5a.

The dilator guide 36 is a rectangular member having first and secondends or sides which engage a first groove 44 in the first side 56 of thewall 34, and a second groove 46 in the opposite second side 58 of thewall. The grooves 44,46 are recessed areas in each of these two sides56,58 having approximately the same height as the thickness of theguide. The engagement of the guide 36 with the grooves 44,46 supportsthe guide in the housing 34 above the bottom end thereof.

The guide 36 is preferably made of a slightly flexible material, such asrubber, and includes a plurality of passages 42 therethrough. Asillustrated in FIG. 4, the passages pass through the guide 36 at about a30 degree angle with respect to vertical. The passages 42 can bearranged in a variety of patterns, depending on the particular dilatorplacement pattern desired.

Each passage 42 is sized to accept a dilator. When the dilators 20 havethe shape described above, the passage 42 is circular in shape, havingapproximately the same diameter as the larger probe portion of thedilator 20.

Stop means retain the dilators in the guide 36 in a first position.Preferably, the stop means comprises friction between the dilators andthe guide 36. In particular, the size of the passage 42 and the type ofmaterial from which the guide 36 is selected so that a dilator 20 placedin a passage is retained therein unless pushed through by an outsideforce. As illustrated in FIG. 4, the passage size varies when thedilator size varies, such that an individual cartridge can contain aguide having passages of differing sizes.

The depressor 38 is located near the top end 39 of the housing 34, andhas a top surface 48, bottom surface 50, and two opposing edges eachhaving an outwardly extending tab 52a,b thereon. The top surface 48 ispreferably flat and smooth for engagement with the thumb 49 or finger ofa surgeon. The bottom surface 50 is "stepped" providing a number ofindividual surfaces arranged parallel to the end of each dilator.

The tabs 52a,b are thin members extending outwardly along opposite edgesof the depressor. The tabs 52a,b each engage a corresponding ledge 54a,bon the first and second sides 56,58 of the housing, acting as means forsupporting the depressor 38 above or at the ends of the dilators 20 in afirst raised position. When a surgeon presses upon the depressor,however, the tabs 52a,b break off, allowing the depressor 38 to movedownwardly within the wall 34 of the cartridge 32.

In the first method, a surgeon uses the cartridge 32 of the presentinvention to simultaneously place a number of dilators 20. First, thesurgeon lifts the fourth side 62 upwardly, exposing the interior portionof the cartridge 32. The surgeon presses a dilator guide 36 into thecartridge, the particular guide chosen to have the desired dilatorinsertion pattern required for that portion of the scalp in which hairgrafts are to be inserted.

FIG. 6 illustrates in overview schematic form how hair grafts 26 ofdifferent sizes are placed in differing regions of the scalp. Along thenormal hair line, many small grafts are inserted. In the central orinterior portion of the scalp, larger hair grafts are inserted. Thus,not only does the "density" of the dilators being placed need to vary,but their size often must vary as well.

Once a guide 36 having the desired dilator pattern (in both size anddensity) is chosen, it is inserted into the cartridge, and the fourthside 62 is pressed downwardly. When relocating the fourth side, thechannels 64,66 slide along and engage the edges of the first and secondsides 56,58, until the stops 68 prevent further downward movement of theside.

Preferably, the appropriately sized dilators 20 are already insertedinto the passages 42 in the guide 36 when the guide is inserted. If not,the surgeon inserts dilators into the passages 42.

The surgeon then places the cartridge 32 on the scalp in the desiredposition, as illustrated in FIG. 5a. In this position, the dilators 20are located proximate the scalp.

The surgeon then presses downwardly on the depressor 38. Pressure on thedepressor breaks off the tabs 52a,b on the edges of the depressor,allowing the depressor to slip downwardly past the ledges 54a,b on thefirst and second sides 56,58 of the wall 34.

The depressor, which engages the handle portions 22 of the dilators 20,presses them downwardly into the scalp. Eventually, further movement ofthe depressor 38 is prevented by its contact with the guide, asillustrated in FIG. 5b.

The cartridge 32 is then removed, leaving the dilators in place in thescalp. The cartridge 32 is easily removed without disrupting thedilators 20 because the dilators no longer engage the guide because thesmall diameter handle portion 22 of each dilator 20 is all that remainsin the larger passages 42 of the guide. Then, as illustrated in FIGS. 2and 3, the surgeon removes the dilators and inserts hair grafts 26 intheir place, completing the transplant process.

Preferably, the range of movement of the depressor 38 against thedilators 20 equals the distance the dilators 20 must be pressed into thescalp for optimum hair graft insertion. In the case where the dilators20 initially just contact the tissue when the cartridge is set on thepatient, this distance is normally about 7 mm. Thus, the depressor's 38range of movement against the dilators is about 7 mm.

The cartridge 32 of the present invention is reusable. In particular,the surgeon removes the old used depressor 38 from the cartridge andreplaces it with a new one having intact tabs 52a,b. When a newdepressor 38 is installed, it is again supported by the tabs 52a,b theledges 54a,b in a raised position.

The surgeon then either inserts new dilators 20 into the passages 42 ofthe guide, or replaces the guide 36 in the cartridge with a differentone if a different dilator insertion pattern is desired.

The above description represents a preferred embodiment of the presentinvention. However, many variations to the method and device arepossible without deviating from the scope of the invention.

For example, the cartridge 32 can have any of a variety of shapes andsizes. Further, the guides can have a variety of sized and spaceddilator accepting passages.

As a further aspect of the present invention, the guide may actuallycomprise a number of individual elements which are arranged together toform a single grid or element in the cartridge. In this fashion, theguide may be "customized" using only a few guides having fixed patterns.For example, the guides may comprise elongate members having a singlerow of passages therein, such that when a number of guides are placedtogether, a grid having numerous rows of differently spaced and sizedpassages results.

While it is desirable that the passages pre-formed in the guide, theguide may be made of a pliable material, whereby the surgeon can formthe passages simply by pressing dilators into the guide in any desiredpattern.

Further, while the passages in which the dilators are located are shownin FIGS. 4, 5a, and 5b as being tilted at a 30 degree angle with respectto the horizontal, the passages can have any orientation. For example,and as illustrated in FIG. 9, the passages can pass vertically throughthe guide. Alternatively, the passages can pass at an angle of 5, 10, or45 or more degrees through the guide. When the angle at which thepassages pass through the guide is different, the bottom surface 50 ofthe depressor is reconfigured so that the depressor engages each dilatorat a right angle.

As described above, preferably the depressor engages the distal end 22of the dilators 20 at a right angle. In an alternate form of the presentinvention, the depressor moves parallel to the direction of dilatormovement through the guide. In particular, the depressor may be locatedon a track in the housing by which the depressor moves downwardlyagainst the dilators at the same angle as the dilators extend throughthe guide.

A variety of means for selectively attaching the guides to the cartridgeother than the engagement with the grooves described above areavailable. For example, the guide may snap into place or be press-fitinto the housing, be held in place by spring-loaded pins which passthrough the cartridge wall into the guide, or simply be supported by aledge extending inwardly from the wall. Also, a variety of means forselectively attaching and detaching the fourth side to access the guidesare possible.

Also, the guide may actually comprise a portion of the housing insteadof a separate element. For example, the guide may comprise a moldedsection of plastic having passages or the like therethrough which isdirectly a part of the outer wall.

As described above, the stop means preferably comprises friction betweenthe dilators and the guide. In this form of the invention, the guide ispreferably constructed of rubber or a similar "stretchable" andhigh-friction material. The guide, however, may be constructed ofplastic or a similar rigid material, with each passage lined with rubberor a similar material.

Also, the stop means for retaining the dilators in the template maycomprise something other than the friction between the dilators and theguide. For example, a thin pierceable member such as a plastic sheet maybe located over the open end of the housing. Alternatively, a removablepanel may be located across the open end of the housing, the panelremoved when the housing is placed on the scalp, there by allowing thedilators to be pressed into the scalp.

A second form of the present invention is illustrated in FIG. 7. FIG. 7illustrates a cartridge 100 for use with an automated gun 101 or otherremote automatic triggering or firing device of the type commonly usedand found in hospitals and medical offices. Such mechanisms are commonlyused to place items such as tissue staples.

In general, the cartridge. 100 comprises a tubular housing 102 rotatablyconnected to a base 104. An actuator 106 passes through the base 104 andinto the housing 102 for pressing a dilator 20 therein out of thehousing and into the scalp of a patient.

The housing 100 is cylindrical in shape, having a first end 108 andsecond end 110. The first end of the housing 108 is enclosed, while thesecond end 110 is open.

The housing 100 is hollow, except for a number of tubes or passages 112extending inwardly from the first end 108. Each tube 112 has a diameterslightly greater than that of a dilator, and having a slightly longerlength. Preferably, the tubes 112 are spacedly located about the outerperiphery of the housing 102, and are open at both ends.

An axle 114 passes from the first end of the housing 102 to the base104. The axle 114 passes along the centerline of the housing 102,allowing the housing 102 to rotate.

The base 104 has a first end 116 for mating engagement with the secondend of the housing 102. The first end 116 of the base is thus circularin shape, comprising an outer wall and inner hollow interior space.

The base 104 includes a second end 118 which is adapted for matingengagement with a triggering device or gun 101. In the embodimentillustrated, the second end 118 has a generally rectangular shape.

An aperture 120 is located in one surface of the second end 118 of thebase 104, forming a passage into the interior of the base. The actuator106 is generally "L"-shaped, extending from the aperture through thebase and into the housing 102. A first end of the actuator 106 extendsupwardly to the aperture 120 for engagement by a trigger mechanism inthe gun 101. A second end of the actuator 106 is located adjacent theend of one of the tubes 112.

Stop means releasably retain the dilators 20 in the tubes 112. The stopmeans preferably comprises friction caused by a slight interference fitbetween the dilator and the housing.

In use, a dilator 20 is placed in each of the tubes 112, with thetapered point facing outwardly. The base 104 of the cartridge 100 islocated in a gun 101, and one of the tubes 112 is aligned with thesecond end of the actuator 106.

The surgeon actuates the gun 101, moving the actuator 106 towards thefirst end of the housing. The second end of the actuator 106 engages theend of the dilator 20 in the aligned tube, pressing the dilator throughthe tube and into the scalp. The surgeon lifts the gun 101 upwardly sothat the housing 102 clears the end of the dilator, and proceeds toplace the next dilator.

A surgeon places the next dilator by rotating the housing 102 withrespect to the base 104, until the second end of the actuator 106 isaligned with another tube containing a dilator. The gun is againtriggered, with the next dilator forced into the scalp.

In this form of the invention, the tube 112 holding the dilator 20 islocated close to the outer edge of the housing 102, so that the nextdilator can be placed very close to the last. Further, the range ofmovement of the actuator 106 is chosen so that the dilator 20 is pressedthe appropriate distance into the scalp.

In this embodiment, the stop means may comprise a separate element suchas a rubbery gasket through which the dilator extends, or a membrane orplate extending across the open end of the tubes which is eitherpierceable or movable when the dilators are depressed into the scalp.

Further, the tubes or passages in which the dilators are located can bearranged in a variety of configurations. A third embodiment device ofthe present is illustrated in FIG. 8. In this embodiment, severaldilators are placed in the scalp automatically when a surgeon operates agun.

In particular, this cartridge 200 is nearly identical to that describedabove, except the tubes 212 in a housing 202 thereof are configured toreceive multiple dilators 20. In the embodiment illustrated, each tube212 is sized to receive seven dilators. The tube 212 thus includes eightdistinct tubes or conduits 213, each of which holds a single dilator.Again, each end of each tube 212, and each passage 213 therein, is open.

In use, when a surgeon actuates the gun or automated firing device, theactuator presses all of the dilators in a tube 212 into the scalp. Inthe configuration illustrated, all eight dilators in the passages in asingle tube are pressed into the scalp.

It is possible to have a wide variety of numbers of tubes and passagestherein, for placing a different number of dilators. Further, thepassages can be arranged in a wide variety of configurations, wherebythe multiple dilators are placed in the scalp in a specificconfiguration.

FIG. 9 illustrates a fourth embodiment device of the present invention.In particular, this variation of the device if similar to thatillustrated in FIG. 4, except that it is automated.

In this form of the invention, a cartridge 300 includes a housing 302with a first bottom open end 304 and second gun-engaging end 306. Adilator guide 308 and depressor 310 are located inside of the housing302.

The second end 306 of the housing 302 is shaped for engagement with theend of a triggering device, such as a spring-loaded or air-powered gun.In the form illustrated, the second end 306 is an elongate, somewhatrectangular shaped member.

The remainder of the housing 302 is box-shaped, except that the firstend 304 is open. Similar to the cartridge 32 illustrated in FIGS. 4, 5aand 5b, a removable dilator guide 308 is located within the housing,recessed a short distance from the open first end 304.

Preferably, a surgeon can open and close one side of the housing 302 toaccess the guide 308, similar to the manner described above in the firstembodiment.

The depressor 310 is located between the guide 308 (at the end of thedilators therein) and the second end 306 of the housing 302. Thedepressor 310 has a perimeter shape which matches the inside shape ofthe housing 302, to be freely moveable between a first retractedposition and a second depressed position.

A bottom surface 312 of the depressor 310 is adapted to press on thedilators at a right angle, as discussed above in more detail.Preferably, the depressor 310 is connected to an actuator 316 whichextends into the second end 306 of the housing for engagement with thegun.

Means for biasing the depressor 310 in the form of a pair of springs318,320 maintain the depressor 310 in a normally retracted position. Thesprings 318,320 are chosen so that upon firing of the gun, the actuator316 moves against the spring force, pressing the actuator downwardlyagainst the dilators.

In use, a surgeon inserts a loaded dilator guide 308 into the housing302 of the cartridge. Once loaded, the surgeon inserts the cartridge 300into a gun. The surgeon then places the open end 304 of the cartridge300 against the scalp of a patient in the desired location.

The surgeon triggers the gun, effectuating movement of the actuator 316and pressing the depressor downwardly against the dilators and theopposing spring force. The dilators are pressed through the passages inthe guide 308 and into the scalp. Once the dilators are placed, thesprings 318,320 bias the depressor back upwardly to the retracted state,when a new loaded dilator guide can be inserted into the cartridge.

In accordance with this method, numerous dilators are simultaneouslyplaced into the scalp using an automated machine. Once again, theparticular location of the dilators is effectuated by choosing a guidehaving a specific configuration of dilator-holding conduits.

While it is preferred that the dilator illustrated in FIGS. 1-3 be usedin the methods and devices of the present invention, otherconfigurations of dilators can be used. For example, FIG. 10 illustratesa second form of dilator 400 for use in the methods and apparatus of thepresent invention. The dilator 400 is similar to that described above,except that it has a hollow passageway 402 along the centerline thereof.This dilator 400 has the effect of coring a section of tissue from thepatient when the dilator is inserted and then removed.

FIGS. 11-13 illustrate a fifth embodiment of the present invention. Inthis embodiment of the present invention, the device for simultaneouslyplacing dilators are interengaging plates or templates, with thedilators comprising a series of spikes on one of the templates. Inparticular, a first or female template 500 comprises a thin base member502 having a top surface 504 and a bottom surface 506. A number ofcylindrically shaped guides 508 depend downwardly from the bottomsurface 506 of the template, each having a tapered or bevelled distalend 509. Each guide 508 has a length nearly equal to the depth the hairgrafts must be placed into the tissue of the patient to maximize graftsurvival.

A passage 510 extends through the top surface 504 of the template downthrough each of the guides 508. The location of each of the guides 508on the template 500 matches the spacing of later to be placed hairgrafts 532.

A second or male template 512 comprises a thin base member 514 having atop surface 516 and bottom surface 518. A number of spikes or probes 520extend downwardly from the bottom surface 518 of the template.

Preferably, the spikes 520 are longer than the passages 510 through thefemale template 500, and have a smaller outside diameter than thediameter of the passages 510 through the guides 508 and passages throughthe guides of a third template described below. The spikes 520 have adistal end which tapers to a point. The spikes 520 are arranged in thesame pattern as the guides 508 on the female template.

As illustrated in FIG. 13, a third template 522 comprises a base plate523 having a top surface 524 and bottom surface 526. A number ofcylindrical guides 528 depend downwardly from the bottom surface 526 ofthe template. A passage 530 extends through the template 522 and each ofthe guides 528. Preferably, the outer dimension of each of the guides528 is smaller than the size of the passage 510 of the female template500. The guides 508 are arranged in the same pattern as the guides 508in the female template 550, for mating engagement therewith.

In use, as illustrated in FIGS. 12 and 13, a surgeon presses the maletemplate 512 into the female template 500. In particular, the surgeonaligns the spikes 520 of the male template with the passages 510 throughthe guides 508 in the female template 500. The surgeon presses the twotemplates 500,512 together until the bottom surface 518 of the maletemplate 512 engages the top surface 504 of the female template. Whenengaging one another, the spikes 520 and guides 508 form "dilators" forplacement in the tissue 534 of the patient. The surgeon places thecombination on the scalp of the patient and presses downwardly until thebottom surface 506 of the female template 500 contacts the scalp,preventing further movement. The surgeon then pulls the male template512 from the female template 500, leaving the female template in place.

When the female template 500 is in place, the passages 510 therethroughform cavities in the tissue of the patient into which hair grafts 532may be inserted. In particular, the surgeon or an assistant places hairgrafts 532 into each of the passages 530 of the third template 522, andthen the surgeon presses the third template into engagement with thefemale template 500 which is engaging the patient.

When the surgeon presses the third template 522 into the female template500, each hair graft 532 is effectively positioned in the tissue of thepatient. Preferably, the surgeon then presses the male template 512 intothe other two templates, whereby the spikes 520 engage the hair grafts532 and push them into the bottom of the formed cavities. The surgeonthen removes all of the templates, leaving the hair grafts 532 in placein the tissue of the patient.

In the above-described device, the templates may comprise substantiallyrigid members made of plastic or similar material. Preferably, however,so that the device can conform to the varying shape of the patient, thebase of each template is constructed of a slightly flexible material,such as a rubber or flexible plastic. The spikes and guides, however, ispreferably constructed of a rigid material which easily penetratestissue.

Further, the size and location of the guides and corresponding spikesmay vary. For example, the guides and spikes may be located on theirrespective bases in a variety of patterns for use in positioning hairgraft in the same variety of patterns on the scalp. Also, the guides,and thus the matching spikes, may vary in size, both between differenttemplate, and even on the same template, depending on the size of hairgraft to be implanted.

FIGS. 14a-d and 15-17 illustrate a sixth embodiment of the presentinvention. The sixth embodiment of the invention is similar to the lastembodiment, except that four plates (instead of three) are preferablyutilized for creation of cavities in tissue and placement of hairgrafts.

This form of the invention comprises a incision catheter plate 602,incision needle plate 604, hair graft catheter plate 606, and hair graftneedle plate 608.

FIG. 14a illustrates the incision catheter plate 602. This plate 602comprises a base 610 having a number of hollow catheters 612 extendingdownwardly therefrom. Each catheter 612 is hollow and aligned with apassageway or bore passing through the base 610.

Means for aligning the plates are provided. Preferably, the meansinclude a guide post 613a,b extending upwardly from the base 610 of theplate 602 at each end thereof. In particular, the each post 613a,bpreferably rises upwardly from the base 610 about 22-30 mm from a smallextension of the base 610. As illustrated, the posts 613a,b arecylindrical in shape, having rounded top ends.

FIG. 14b illustrates the incision needle incision plate 604. The plate604 comprises a base 614 having a number of spikes 616 extendingdownwardly therefrom. Preferably, the base 614 has approximately thesame dimensions as the base 610 of the incision catheter plate 602. Thespikes 616 are arranged on the bottom of the plate 604 in the samepattern and position as the catheters 612 of the incision catheter plate602, whereby a user may align the spikes 616 with the catheters 612 andpress the spikes into engagement with the catheters. Each spike 616 ispreferably a cylindrical member which near the free end thereof tapersto a sharp point.

A bore 618a,b is located in the base 614 of the incision needle plate604 at an extension of each end of the base. The bores 618a,b arepositioned in the plate 614 for alignment with the posts 613a,b risingupwardly from the incision catheter plate 602.

In use, and as illustrated in FIGS. 15 and 16, a user aligns the bores618a,b of the incision needle plate 604 with the posts 613a,b of theincision catheter plate 602 and presses the two plates together untilthe base 614 of the incision needle plate 604 is resting on top of thebase 610 of the incision catheter plate 602. As illustrated in FIG. 16,when the two plates 602,604 engage one another, the spikes 616 andcatheters 612 interengage to form solid "needles" for penetration of thetissue of a patient.

The catheters 612 are each preferably about 5-9 mm, and most preferablyabout 5-7 mm long, and 1-4 mm in inner diameter. The outer diameter ofeach spike 616 is preferably nearly equal, but always slightly lessthan, the inner diameter of each catheter 612. This allows each spike616 to pass into each catheter 612 and leave little if any spacetherebetween, whereby tissue can not become entrapped between theinterengaging spikes/catheters when they are pushed into the scalp.Further, the lengths of the catheters 612 and spikes 616 are chosen sothat their total length is sufficient to create an aperature in thetissue of sufficient depth for proper hair graft placement (normallyabout 6-8 mm).

Once pressed into the tissue as illustrated in FIG. 16, the incisionneedle plate 604 is removed. The incision catheter plate 602 remains inplace, with the catheters 612 thereof forming apertures in the tissuefor placement of hair grafts.

Preferably, the user utilizes the hair graft catheter plate 606 and hairgraft needle plate 608 for placement of the hair grafts.

The hair graft catheter plate 606 comprises a base 620 having a numberof catheters 622 extending downwardly therefrom. As with the catheters612 of the incision catheter plate 602, these catheters 622 arepreferably hollow, and aligned with passages or bores passing throughthe base 620. The catheters 622 are arranged on the bottom of the base620 for engagement with the catheters 612 of the incision catheter plate602.

Bores 624a,b extend through an extension portion of each end of the base620. The bores 624a,b are position on the base 620 for alignment withthe posts 613a,b of the incision catheter plate 602.

The hair graft needle plate 608 comprises a base 626 having a number ofcylindrical, blunt end rods 626 extending downwardly from a bottomsurface thereof. The rods 626 are arranged for engagement with thecatheters 612,622 of the incision catheter plate 602 and hair graftcatheter plate 606, respectively.

Bores 630a,b are located in the base 626 of the plate 608 at extensionportions thereof. The bores 630a,b are sized and positioned to allow theposts 613a,b of the incision catheter plate 602 to pass therethrough.

In use, a user loads hair grafts into the catheters 622 of the hairgraft 632 catheter plate 606. The user then aligns the bores 624a,b ofthis plate 606 with the posts 613a,b of the incision catheter plate 602,and presses the hair graft catheter plate 606 downwardly until base 620thereof engages the base 610 of the incision catheter plate 602 (seeFIG. 17).

The catheters 622 of the hair graft catheter plate 606 are sized toslide within the catheters 612 of the incision catheter plate 602. Forexample, when the inner diameter of each catheter 612 of the incisioncatheter plate 602 is about 1.7 mm, the outer diameter of each hairgraft catheter plate catheters 622 is about 1.2 mm. Further, it ispreferred that the hair graft catheter plate catheters 622 extend intothe tissue to almost an equal depth of the incision catheter platecatheters 612. To compensate for the thickness of the incision catheterplate base 610, this means the hair graft catheter plate catheters 622must be slightly longer that the incision catheter plate catheters 612.

The user utilizes the hair graft needle plate 608 to press the hairgrafts 632 from the catheters 612,622. The user aligns the bores 630a,bof the hair graft needle plate 608 with the posts 613a,b of the incisionneedle plate 602 and presses the hair graft needle plate 608 downwardly,as illustrated in FIG. 17. Once fully depressed, the user lifts thecombined and stacked incision catheter plate 602, hair graft catheterplate 606 and hair graft needle plate 608 from the tissue, leaving thehair grafts 632 implanted in the tissue.

The rods 622 of the hair graft needle plate 608 preferably have an outerdiameter which is slightly less than the inner diameter of the hairgraft catheter plate catheters 628. The rods 622 are preferably longenough so that they extend to near the bottom of the incision catheterplate catheters 612 when engaged therewith. One of the advantages ofusing a fourth plate--the hair graft needle plate 608--instead of thethree plate arrangement described above is that the lengths of the rods622 can be chosen so that they do not extend outwardly from the ends ofthe catheters 612 like would happen if the spikes 616 of the incisionneedle plate 604 were used for this task. This prevents the user fromdriving the hair grafts into the tissue of the patient.

Second, the shape of the rods 622 allows for more effective displacementof the grafts from the catheters than when using a pointed spike. Use ofthe flat ended rod 622 presents less risk of damage to the hair graft.

As with the previously-described form of the invention, the plates maycomprise substantially rigid members made of plastic or similarmaterial. In some instances, however, the plates may be constructed of aslightly flexible material so that they can conform to the tissuecontour of the patient. The spikes, rods, and catheters, however, arepreferably constructed of a rigid material which easily penetratestissue.

While the spikes, rods, and catheters are illustrated in two rows ofspaced-apart members, their location may vary. In particular, thespikes, rods and catheters may be arranged in any variety of patternsfor use in locating hair grafts in the same variety of patterns in thescalp.

Advantageously, in this form of the invention, the interengagement ofthe incision needle plate spikes 616 with the incision catheter platecatheters 612 forms, in essence, a single rigid "needle" for forming anaperture in tissue. This is advantageous over use of a regular dilatoror a catheter for several reasons. First, use of a catheter alone mayresult in tissue being forced into the interior of the catheter, thusblocking hair graft placement. Alternatively, use of a dilator alone canbe difficult, because when the dilator is removed, the aperature in thescalp often closes, preventing positioning of the hair graft in thetissue.

Further, in this and the last form of the invention, the catheters orguides and spikes and rods can be located at an angle of other thanperpendicular to the base of each respective plate. In this manner, auser can create an aperature in the tissue which lie at an angle otherthan perpendicular thereto. This is important, for most hair growsnaturally from the scalp at other than an angle of perpendicularthereto. Use of template or plates having members extending at an angleof other than perpendicular to the scalp allows placement of hair graftsat a similar angle in the scalp.

Another aspect of the last two forms of the invention which isadvantageous is that a hair grafts can be pre-loaded into a number ofplates/templates for later use. With several separate plates/templatespre-loaded, a user can very quickly create apertures with the othermembers and then place large numbers of hair grafts very quickly.

The spikes may have forms other than that described above. Inparticular, the spikes may have a "body" which is smaller in diameterthan the tip. The spikes may also have a tip which comprises a thinblade-like element as opposed to a point. In some instances, it mightalso be desirable for the spike to be hollow instead of solid.

The wall of the catheter at the end thereof may be tapered or sharp toaid in the insertion of the device into the tissue. Alternatively,instead of the wall of the catheter ending perpendicular to the lengthof the wall, the end of the catheter may be entirely tapered.

Also, the shapes of the plates (or bases thereof) may vary widelydependent upon the area of tissue in which the grafts are to be planted.For example, the plates may be round, square, or irregular-shaped. Themeans for aligning the plates may include other types of guides or othersimilar members known in the art.

Yet another variation of the present invention is illustrated in FIGS.18-19. In this variation of the invention, the templates or plates ofthe above-described versions of the invention are "mechanized" forfaster graft placement.

The device 700 of this form of the invention comprises a first or lowerplate 702 having two upwardly extending guides 704,706, an upper orsecond plate 708 movably mounted on the guides, and a cartridge 710located between the upper and lower plates.

The lower plate 704 comprises a base member 712 having a number ofhollow catheters 714 extending downwardly therefrom and aligned withbores 716 passing through the base. The catheters 714 are arranged onthe base 712 in the same pattern in which hair grafts will ultimately beimplanted in the tissue of a patient.

The base 712 is preferably fairly rigid and constructed of a durable,sterilizable material, such as plastic. The base 712 is preferablyelongate in shape, having first and second ends located outwardly of thebores 716.

Preferably, means for guiding the upper plate 708 between a first raisedand a second lowered position are provided. The means preferablycomprises guides 704,706 extending upwardly from the ends of the plate702.

The first guide 704 is a flat member extending upwardly from itsconnection to the base 712 of the lower plate 702. The guide 704 isfairly wide to accommodate an indentation 718 therein. A stop 720 islocated at an end of the guide 704 located opposite the lower plate 702,for limiting the upward movement of the upper plate 708 thereon.

The second guide 706 is a cylindrical post extending upwardly from theend of the base 712 of the lower plate 702 opposite the first guide 704.Both the first and second guides 704,706 are preferably made of adurable and sterilizable material, and have a length sufficient to allowtravel of the upper plate 708 between the positions described below.

The upper plate 708 is preferably shaped similar to the lower plate 702,comprising a base 722 having a number of spikes 724 extending downwardlytherefrom. The spikes 724 are cylindrical members having pointed tipswhich are sized for insertion into the hollow catheters 714 of the lowerplate 702. The length of each spike 724 is chosen such that it extendsslightly from the end of the catheter 724 when pressed downwardlytherethrough as described below.

First and second passages are located in the upper plate 708 foracceptance of the first and second guides 704,706, whereby the upperplate 708 may slide up and down along the guides.

As illustrated in FIG. 18, the cartridge 710 comprises a wheel rotatablymounted on the second guide 706 between the lower and upper plates702,708. The cartridge 710 preferably has a radius equal to the distancebetween the first and second guides 704,706.

A number of bores 726 pass through the cartridge 710 from a top surface728 to a bottom surface 730 thereof. The distance between the top andbottom surfaces 728,730 is great enough that a hair graft may bepositioned inside each bore 726. Preferably, the bores 726 are arrangedin sets about the cartridge. One set is illustrated in FIG. 18. Othersets of bores 726 (not illustrated) are located about the linesillustrated on the top surface 728 of the cartridge 710.

Each set of bores 726 includes a number of bores equal in number to thespikes 724 and catheters 714, and arranged in the same pattern.

Means for aligning the sets of bores 726 of the cartridge 710 with thespikes 724 and catheters 714 of the plates 702,708 are provided.Preferably, this means comprises a number of beads 732 located on thecartridge 710 and the indentation 718 in the first guide 704.

The beads 732 are located on the outwardly facing surface of the outeredge of the cartridge 710. These beads 732 extend slightly outwardly ofthe cartridge for engagement with the indentation 718 in the first guide704. The beads 732 are positioned on the cartridge 710 such that when abead 732 engages the indentation 718, one of the sets of bores 718 isaligned with the spikes 724 and catheters 714.

Use of this form of the invention is as follows. A user aligns an emptyset of bores 726 of the cartridge 710 with the spikes 724 and catheters714. The user accomplishes this by raising the upper plate 708 along theguides 704,706, and then rotating the cartridge 710 until one of thebeads 732 engages the indentation 718.

The user then presses the upper plate 706 downwardly, passing the spikes724 through the bores 726 in the cartridge and into the catheters 714.At this time, the tips of the spikes 724 protrude slightly from the endsof the catheters 714, such that the spikes and catheters interengage toform "needles." The user then presses the device 700 downwardly so thatthe spikes 724 and catheters 714 enter the tissue of a patient. The userstops when the lower plate 702 rests on the tissue of the patient.

The user then raises the upper plate 708 until the spikes 724 arelocated above the cartridge 710. The user rotates the cartridge 710until a set of bores 726 containing hair grafts is aligned with thespikes 724. The user or another party can load any of the other sets ofbores 726 with hair grafts before or during the procedure. Inparticular, a user places hair grafts into any or all of the bores 726.

Once aligned, the user presses the upper plate 708 downwardly. As theupper plate 708 moves downwardly, the spikes 724 press the hair graftsin the bores 726 down into the catheters 714. The user then raises theupper plate 708 and removes the device 700 from the tissue. A hair graftis left in the tissue of the patient in each spot corresponding to wherea catheter 714 penetrated the tissue and a hair graft was pressedtherein.

The user then aligns an empty set of bores 726 so that the spikes 708can be lowered therethrough and used to reinsert the device into thetissue of the patient in a new location.

Advantageously, this device 700 allows a user to preload several sets ofbores 726 with hair grafts, whereby the device may be used to placeseveral sets of hair grafts in very quick succession.

As illustrated in FIG. 19, a similar result can be achieved when thecartridge 710 used with the device is not a wheel but comprises a singlesegment. In this version, a cartridge 740 takes the form of arectangular segment having a first end 742 and a second end 744. Bores746 like those described above pass through the cartridge 740.

The first end 742 of the cartridge 740 is designed for engagement withthe first guide 704. In particular, the first end 742 of the cartridge740 preferably includes a bead 748 extending outwardly therefrom forengagement with the indentation 718 in the first guide 704.

The second end 744 of the cartridge 740 is designed for engagement withthe second guide 706. Preferably, the second end 744 of the cartridge740 has a semi-circular cut-out.

In use, the user presses the second end 744 of the cartridge 740 intoengagement with the second guide 706. The user rotates the cartridge 740into place when the bead 748 thereon engages the indentation 718 in thefirst guide 704.

A user utilizes an empty cartridge 740 when inserting the device 700into the tissue of a patient. The user utilizes a cartridge 740 havingbores filled with hair grafts when ready to insert the grafts.

Advantageously, the user may replace cartridges 740 as needed, and whena user has a number of cartridges 740, several may be pre-loaded withhair grafts for quick placement of large numbers of grafts.

In this form of the present invention, it is also possible for device700 to be configured for placement of hair grafts at an angle into thetissue. The catheters, spikes and bores may be angled (at other thanperpendicular to the plates/cartridge) for placement of the grafts. Inthat instance, the guides 704,706 should also be angled to permitsliding of the upper plate 708 up and down while the spikes move in andout of the bores/catheters.

It will be understood that the above described arrangements of apparatusand the method therefrom are merely illustrative of applications of theprinciples of this invention and many other embodiments andmodifications may be made without departing from the spirit and scope ofthe invention as defined in the claims.

I claim:
 1. A device for placement of hair grafts in the tissue of apatient, comprising:a first plate comprising a base member having anumber of first bores passing therethrough and a number of hollow firstcatheters extending therefrom and aligned with said first bores; asecond plate comprising a base having a number of first spikes extendingtherefrom, said spikes arranged and sized for location within said firstcatheters; a third plate having a base with a number of second borespassing therethrough and a number of hollow second catheters extendingtherefrom and aligned with said second bores, said second catheterssized for location within said first catheters; and a fourth platehaving a base with a number of second spikes extending therefrom, saidsecond spikes arranged and sized for location within said secondcatheters.
 2. The device of claim 1 further including means on saidfirst plate for aligning said plates for registry of said first spikeswithin said first catheters and said second spikes within said secondcatheters.
 3. The device of claim 2, wherein said means for aligningcomprises two posts extending upwardly from said first plate and twobores located in each of said second, third, and fourth plates forpassage of said posts therethrough.
 4. A method of locating a pluralityof hair grafts in the tissue of a patient, comprising the stepsof:locating a plurality of spikes extending downwardly from a basemember of a first plate into a plurality of hollow guide membersextending downwardly from a base member of a second plate; pressing saidspikes in said guide members into the tissue of the patient; removingsaid first plate from said second plate; placing a plurality of hairgrafts into the plurality of guide members of said second plate; andremoving said second plate from the tissue of the patient.
 5. The methodof claim 4, wherein said placing a plurality of hair grafts into theplurality of guide members comprises the steps of:pressing a number ofcatheters extending downwardly from a third plate into said guidemembers of said second plate; and pressing a number of spikes extendingdownwardly from a fourth plate into said catheters of said third plate.6. The method of claim 5, further including the step of locating hairgrafts into said catheters of said second plate.
 7. A device forplacement of a number of hair grafts in tissue of a patient comprising:alower plate having a number of bores therein and a number of hollowcatheters extending from said plate and aligned with said bores; anupper plate movably mounted to said lower plate, said upper plate havinga number of spikes extending therefrom; a cartridge located between saidupper and lower plates, said cartridge having a set of bores thereincorresponding to said spikes in said upper plate.
 8. The device of claim7, wherein further including a pair of guides extending upwardly fromsaid lower plate, said upper plate mounted on said guides.
 9. The deviceof claim 7, wherein said cartridge comprises a wheel rotatably mountedto said lower plate.
 10. The device of claim 9, wherein said cartridgeincludes more than one set of bores.
 11. The device of claim 9, whereinsaid cartridge is rotatably mounted on a post extending upwardly fromsaid lower plate.
 12. The device of claim 7, further including means foraligning said bores with said spikes.
 13. The device of claim 12,wherein said means for aligning includes at least one bead located onsaid cartridge.